Prominent ear and nose deformity is common amongst the human population.
Firstly the problem of ear deformity will be considered. An ear which projects more than 17 mm from the side of the head is usually perceived as prominent. By this estimate, up to 5% of the population may be affected. Both ears are commonly affected, although occasionally just one side is prominent. The prominence may be the result of a poorly formed or absent antihelical fold (FIGS. 1 and 2). Or it may be the result of a deep conchal fossa (FIGS. 1 and 3). Alternatively, both of these abnormalities may need to be addressed when correcting prominent ears.
There are a number of known methods for addressing the problem of prominent ears. These methods may be divided into two categories, those involving otoplasy surgery (a procedure to change the shape of the ear) and those avoiding surgery. Examples of each of these categories will now be briefly discussed.
A number of operations (otoplasty surgery) are available to correct ear deformities. These vary from very invasive procedures to reshape the cartilage to minimally invasive procedures. The principle involved in all of these procedures is reshaping of the cartilage which gives the ear its prominence.
Standard, invasive, otoplasty surgery is a lengthy procedure which takes approximately 90 minutes (45 minutes for one ear). A large number of complications have been associated with this type of surgery. These include: problems with infection, bleeding, skin necrosis, death from general anaesthesia, recurrence of the prominence, keloid or hypertrophic scarring, asymmetry, palpable sharp edges (where the cartilage has been cut), pain, numbness and cold intolerance/sensitivity.
Minimally invasive otoplasty procedures (using needles or similar instruments) to reshape the cartilage have fewer complications and take less time (15 minutes for each ear), but are also less successful at achieving corrections of ear prominence. Asymmetry and palpable sharp edges are also more common compared with standard otoplasty surgery.
A further disadvantage of both standard otoplasty surgery and minimally invasive otoplasty procedures is that surgeons must undergo lengthy and costly training to learn the relevant surgical techniques. Furthermore, the results of the first 10-20 cases are likely to be unpredictable. There is currently no means by which this can be avoided.
To avoid some of the problems associated with otoplasty surgery several devices have been developed to correct prominent ears, which avoid surgery altogether.
An example of such a device is known as Earbuddies.™. At birth and for a variable time afterwards (up to six months), the cartilage of the human ear remains soft and deformable. Therefore, external forces applied to the cartilage can result in permanent changes to its shape. After six months, the cartilage becomes more firm and more resistant to deformation. In the first few years of life, Earbuddies.™. take advantage of the deformability of the cartilage. A piece of soft wire coated in silicone (for comfort) is moulded and placed onto the outside of the ear and taped into position (FIGS. 4a to 4c). The cartilage moulds its shape to that of the ear buddy and any prominence is corrected. More information on how the device is used is available from the website for the device at http://www.earbuddies.co.uk/pws/index.htm. Earbuddies.™. are very successful when used in children up to the age of about 6 months. Thereafter, the cartilage becomes more firm and the length of time that the splint needs to remain in place to exert an effect makes it impractical to use. This is compounded by the increasing dexterity of the child who will try (and usually succeed) in removing the splint, thereby reducing its effectiveness.
An alternative device, which avoids the need for surgery is known as Auri.®.Clip. The Auri.®.Clip applies gentle, continuous, external pressure to the cartilage of the ear in the region of the antihelical fold (FIGS. 1, 5, 6). This deforms the cartilage in this area over a prolonged period of time to make the ears lie flatter against the head. The Auri.®.Clip forms part of the patented Auri.®.Method which consists of three products:                i) The Auri.®.Clip.        ii) The Auri.®.Strip, a special plaster.        iii) The Auri.®.Protective Spray.        
According to the manufacturer, the Auri.®.Clip is a brace measuring 1 inch (2.5 cm) on all sides which is fixed to the ear during the night or day (FIGS. 5a and 5b). It consists of three parts: the part behind the ear, the part in front of the ear, and a lock. The Auri.®.Strip is a very thin (0.2 mm thick), transparent and double-sided medical adhesive material that is invisible when worn and can also be used to reshape the antihelical fold (FIGS. 6a to 6c). The Auri.®.Protective Spray is used together with the Auri.®.Clip and Auri.®.Strip to prevent problems with skin irritation due to prolonged usage of the Auri.®.Clip. The makers claim that 3 to 6 months treatment is enough to have a permanent effect. More information on the use of the device is available from http://www.aurimethod.com/index.htm.
This technique has the disadvantage that the clips cause skin irritation in some patients. Furthermore, correction of the deformities may not be complete.
Nose deformities are also common in the human population. Deformities of the nose include, for example, having a broad tip, bifid tip or cleft tip. Rhinoplasty (nose shaping surgery) has conventionally been used to address these deformities. Noses may be made smaller using reduction rhinoplasty, or enlarged using augmentation rhinoplasty. Such surgery usually involves separating the skin of the nose from its supporting framework of bone and cartilage. In conventional rhinoplasty both the bone and the cartilage may need to be reshaped. Bone, which forms approximately one-third of the nose, is relatively easy to reshape. In contrast, cartilage, which forms the remaining two-thirds, is relatively difficult to reshape. This is particularly true for the tip of the nose.
There are several disadvantages of conventional rhinoplasty. For example, traumatic dissection of the nose may damage nasal cartilages. There is also a risk of skin necrosis. Furthermore, asymmetry may be made worse by surgery. Cartilage grafts are often in short supply, especially in revision procedure and in cleft lip noses. Furthermore, the operations are often lengthy and the surgeon must be highly skilled. Training of a sufficiently skilled surgeon to perform rhinoplasty is time consuming and costly. Moreover, there are disadvantages of conventional rhinoplasty to the patient. The operation may be painful and there is a risk of adverse reaction, or even death due to the general anaesthetic. Furthermore, the results of surgery may be unpredictable and irregularities may be observed, particularly on the tip or dorsum. There is also a risk of recurrence of the deformity.